Internet addiction and anxiety-depressive comorbidity among chinese adolescents: the mitigating effects of physical activity in a large-scale cross-sectional study

作者：Xianwei Zhang, Jing Nie, Zhiying Sun, Xiaoyang Wang, Ke Xu, Fengqin Li, Zhonghui Liu · 发表于：BMC Public Health · 年份：2025 · DOI：10.1186/s12889-025-24137-6 · 被引用次数：12 · 研究领域：Impact of Technology on Adolescents、Eating Disorders and Behaviors、COVID-19 and Mental Health

OBJECTIVE: This study aimed to examine the associations between internet addiction (IA), physical activity (PA), and mental health comorbidities (depression, anxiety, and their co-occurrence) among Chinese adolescents, and assess the mediating role of PA in the IA-mental health relationship. METHODS: A cross-sectional analysis was conducted using data from the 2024 National Student Common Diseases and Risk Factors Surveillance (NSCDRFS) in Tianjin, China, involving 20,692 adolescents aged 12-19 years. IA was assessed via a DSM-5-derived 9-item scale (cutoff ≥ 5). PA levels were categorized as insufficient (≤ 2 days/week of moderate-to-vigorous activity). Mental health outcomes included depressive symptoms (CES-D ≥ 16), anxiety symptoms (GAD-7 ≥ 10), and anxiety-depression comorbidity (ADC), defined as meeting both depression (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10) diagnostic criteria. Multivariable logistic regression and mediation analyses were performed to evaluate direct and indirect pathways. RESULTS: Adolescents with IA exhibited significantly higher risks of anxiety (OR = 1.80, 95% CI: 1.68-1.91), depression (OR = 1.99, 95% CI: 1.88-2.11), and ADC (OR = 2.12, 95% CI: 2.00-2.25) compared to non-IA peers (all P < 0.001). Insufficient PA independently increased risks of anxiety (OR = 1.17), depression (OR = 1.27), and ADC (OR = 1.23). Mediation analysis revealed that PA accounted for only 3.5-4.3% of the total effects of IA on mental health outcomes, with direct effects rema...